title: Detection of tumor progression in optic pathway glioma with and without neurofibromatosis type 1.
abstract: BACKGROUND
  We wanted to determine the sensitivity and specificity of serial changes in visual acuity and visual evoked potentials (VEPs) to detect radiological progression of tumor volume in children with optic pathway gliomas.
  
  
  METHODS
  From a retrospective review of a cohort of 69 patients, 54 patients met inclusion criteria (31 with primary chemotherapy, 4 with primary radiotherapy, and 19 with stable tumor volume and no treatment). Age at presentation ranged from 0.3 to 13 years. Patients were serially followed by MRI, age-corrected visual acuity in log minimum angle of resolution (logMAR), and pattern VEP. Longitudinal data averaged 7.9 years (range 0.5-16 y). Visual assessments were aligned with MRI data within 6-month intervals. Tumor progression was defined by 25% or greater increase in volume.
  
  
  RESULTS
  Visual acuity in the better eye had poor sensitivity and specificity for detecting tumor volume progression (0.5 and 0.5, respectively). Visual acuity in the worse eye showed worse sensitivity and specificity because false positives (visual decline without tumor progression) were more frequent than true positives (visual decline with tumor progression). VEPs showed slightly better sensitivity and specificity (0.69 and 0.58, respectively). In patients with stable tumors, visual acuity fluctuated ±0.55 logMAR (SD = 0.15) between examinations. VEP amplitude fluctuated -0.74 to 0.48 log units (SD = 0.19) between examinations.
  
  
  CONCLUSIONS
  Serial changes in visual function do not reliably detect tumor progression. Conversely, tumor progression does not reliably indicate decreased visual function. Objective visual function and serial MRIs are complementary in management of optic pathway gliomas.
authors.affiliation: Corresponding Author: Avery H. Weiss, MD, Division of Ophthalmology, OA.9.220, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105. avery.weiss@seattlechildrens.org.
authors.forename: John P
authors.initials: JP
authors.lastname: Kelly
authors.forename: Avery H
authors.initials: AH
authors.lastname: Weiss
mesh_terms: D001921:Brain / Q000473:pathology / Q000503:physiopathology; D018450:Disease Progression; D005074:Evoked Potentials, Visual; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009456:Neurofibromatosis 1 / Q000150:complications*; D020339:Optic Nerve Glioma / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011859:Radiography; D014792:Visual Acuity / Q000502:physiology*
keywords: optic pathway glioma; tumor progression; visual acuity